title: CT scan utilization patterns in pediatric patients with recurrent headache.
abstract: Although unnecessary for children with headache and normal history, computed tomography (CT) scans are widely used. This study sought to determine current practice patterns of neuroimaging to diagnose pediatric headache in a variety of treatment settings and to identify factors associated with increased use of neuroimaging.
  
  
  METHODS
  This retrospective claims analysis included children (aged 3–17 years) with ≥2 medical claims for headache. The primary outcome was CT scan utilization on or after first presentation with headache in a physician’s office or emergency department (ED).
  
  
  RESULTS
  Of 15 836 patients, 26% (4034 patients; mean age: 11.8 years) had ≥1 CT scan, 74% within 1 month of index diagnosis. Patients with ED visits were 4 times more likely to undergo a CT scan versus those without ED visits (P < .001 [95% confidence interval: 3.9–4.8]). However, even outside the ED, use of CT scans remained widespread. Two-thirds of patients with CT scans had no ED use.Among patients with no ED utilization, >20% received a CT scan during the study period. Evaluation by a neurologist was strongly associated with a lower likelihood of CT scan compared with other provider specialties (odds ratio: 0.37; P < .01 [95% confidence interval: 0.30–0.46]).
  
  
  CONCLUSIONS
  Use of CT scans to diagnose pediatric headache remains high despite existing guidelines, low diagnostic yield, and high potential risk. Implementing quality improvement initiatives to ensure that CT scans in children are performed only when truly indicated will reduce unnecessary exposure to ionizing radiation and associated cancer risks.
authors.affiliation: HealthCore, Inc, Wilmington, DE 19801, USA. adevries@healthcore.com
authors.forename: Andrea
authors.initials: A
authors.lastname: DeVries
authors.forename: Paul C
authors.initials: PC
authors.lastname: Young
authors.forename: Eric
authors.initials: E
authors.lastname: Wall
authors.forename: Thomas ScD
authors.initials: TS
authors.lastname: Getchius
authors.forename: Chia-hsuan
authors.initials: CH
authors.lastname: Li
authors.forename: John
authors.initials: J
authors.lastname: Whitney
authors.forename: Alan
authors.initials: A
authors.lastname: Rosenberg
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000000981:diagnostic imaging / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003299:Cooperative Behavior; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006261:Headache / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D020773:Headache Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D033183:Interdisciplinary Communication; D016013:Likelihood Functions; D008297:Male; D008881:Migraine Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology; D009460:Neurologic Examination / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data